BISAP Score as a Superior Predictor for Severe Acute Pancreatitis Compared to Ranson's Criteria: A cross sectional study

Abstract

Background: Acute pancreatitis (AP) is an inflammatory condition of the pancreas characterized by activation of pancreatic enzymes to cause self-digestion of the pancreas, which presents as a mild upper abdominal discomfort with local inflammation to severe disease with multi-organ failure. It has a mortality of approximately 1% among all AP but it might be as high as 20% to 30% among those with severe acute pancreatitis (SAP). In clinical practice, accurate classification of the severity of acute pancreatitis is valuable in reducing mortality by clinical decision-making and action. The aim of this study is to compare the accuracy of BISAP scoring system and Ranson scoring system in predicting severity of acute pancreatitis. Methods: This Is an observational, cross-sectional study conducted using a non-probability purposive sampling method. Result: A total of 25 patients with first episode of Acute Pancreatitis admitted were evaluated. Result: BISAP score of less than or equal to 3 predicted 93.75% of severe attacks and 83.3% of mild attacks with a PPV of 93.75% and NPV of 83.3% and accuracy of 90.09%.  Ranson’s score of greater than or equal to 4 predicted 42.8 % of severe attacks and 75 % of mild attacks with a positive predictive value of 33.33% and negative predictive value of 75% and accuracy of 60%. BISAP score has a better sensitivity, specificity, PPV, NPV and Accuracy than Ranson score in predicting the severity of AP putting the cutoff score >3 for both the scoring systems. Conclusion: BISAP scoring system is very simple, cheap, easy to remember and calculate. It is instantaneous and there is no time delay in contrast to Ranson’s score. It is also found to be superior to RANSON’s score in predicting severity.

Keywords: Acute Pancreatitis, Accuracy, BISAP score, Ranson Score, Severity